Why COVID-19 booster shots may be the next best strategy for colleges

The big question for institutions to ask as immunity from the vaccines wanes: What is the definition of 'fully vaccinated?'
By: | November 22, 2021
Photo courtesy of Centers for Disease Control and Prevention

A rise in COVID-19 case counts in several states and at a number of higher education institutions—including the University of Michigan and Berklee College of Music in Boston—how the staying power of the delta variant and how delicate the balance of mitigation strategies can be.

Although colleges and universities have done well to balance reopenings with a mix of safety protocols, public health experts have expressed concern about the potential for outbreaks as coronavirus and flu combine with holiday gatherings through the winter.

A map of cases across the United States from the New York Times shows a clear pattern: Those in cold-weather states are experiencing much higher levels of positivity than those in southeastern states and California. That’s not because COVID-19 struggles to survive in warm weather but because when it gets cold, people head inside, where spread can occur more easily.

“When you add indoors with the removal of some of the mitigation methods—masks, distancing, some testing—we’re going see cases go up,” says Gerri Taylor, co-chair of the American College Health Association’s COVID-19 Task Force, which assists college health centers. “We did not expect this. We were really expecting and hoping that things would be OK. There were a number of cases around Halloween, and I think there’s going to be another bump with Thanksgiving and then with Christmas, Hanukkah, and New Year’s. It’s a concerning time.”

Because of those spikes, institutions have sent up warnings to their communities about indoor gatherings as they head home for breaks. They are not only continuing to encourage vaccinations but pushing booster shots after the Centers for Disease Control and Prevention expanded eligibility to all adults over 18 last Friday.

Third doses likely will become the most discussed strategy on campuses heading through the next few months. While the majority of students, staff and employees have gotten vaccinated – either on their own or because of mandates—many could need third doses to remain ahead of COVID-19. Those who do will see 90% effectiveness against severe outcomes.

“You keep hearing the term ‘fully immunized.’ So what is the definition of fully immunized?” Taylor says. “Does it mean two doses? Does it mean two doses and a booster? We’re looking to the CDC to define that.”

Many public health officials are asking the same questions. The FDA gave emergency use authorization to Pfizer’s vaccine in mid-April to those 16-and-over. So if some started receiving doses in early May, they already have hit the six-month threshold where waning immunity begins to occur. Gathering now, they might be susceptible if even they’ve had two doses. “When people are telling me they’re going to Thanksgiving and the people are fully vaccinated, if they’re with somebody who is vaccinated and their last shot was eight months ago, are they really fully vaccinated?” Taylor asks.

Will boosters become a requirement?

There are more than 1,000 colleges and universities that have vaccine requirements in place, but none currently have mandates for booster shots. It is unclear whether they will, although it is something to be considered, particularly if the CDC offers further guidance specific saying all age groups should get the third dose. Right now, it says they may get it.

“I don’t think colleges are going to immediately jump to do any kind of requirements at this time,” Taylor says. “It’s so fresh and new. It’s going to take a while before they really decide. I’m sure we’re going to be recommending them. I don’t know that we’re going to make a statement about requiring them.”

One of the roadblocks to an institutional mandate is ensuring that populations can get them. That means additional staff and costs to both help students and faculty get doses but also to track and monitor them. “The costs are astronomical,” Taylor says. “And the biggest concerns of health centers are burnout and staffing. Now you’re going to add a booster? If colleges require it, they’ll need another significant system put into place. They need staff to do it, to track the vaccine and to keep records. Boosters are important. But do you have the staff?”

Either way, colleges and universities may want to consider tracking who receives third doses and including numbers on the COVID dashboard while maintaining their own records. “Even if they’re not requiring it, they should have the records that say, for example, 10 people in this dorm have had the third vaccine,” Taylor says. “It would be nice to know that.”

Short of a booster mandate, Taylor says colleges also should be watching closely flu cases and other variants, although delta remains the dominant strain. She says HEPA filtration is helping, particularly in health centers and in other key places on campus. Re-masking is another possibility.

“We’re saying to colleges if things are going really well in their community, then maybe they can step down on masking,” she says. “The problem is once you step down, how do you reinforce it if cases go up? There’s a lot of confusion out there. There are experts that say you don’t have to wear your mask now. And then other experts say to keep the mask on if you’re with unvaccinated people, but if you’re vaccinated, you don’t need to mask. Again, what is vaccinated at this point?”